Tuesday, June 13, 2017

New Rule May Worsen Backlog For Social Security Disability Claimants

(Stephenie Hashmi, above right, keeps her husband Shawn
company in the kitchen while he prepares dinner. She has appealed the
Social Security Administration's denial of her claim for disability
benefits.)

By
the time Stephenie Hashmi of Lenexa, Kansas, was in her mid-20s, she
had achieved a lifelong dream: She was the charge nurse at one of Kansas
City’s largest intensive care units. But even as she cared for
patients, she realized something was off with her own health.
“I remember just feeling tired and feeling sick and hurting, and not knowing why my joints and body was hurting,” Hashmi says.
Hashmi was diagnosed with systemic lupus, a disease in which the body’s immune system attacks its own tissues and organs.
She’s
had surgeries and treatments, but now, at age 41, Hashmi is often
bedridden. She finally had to leave her job about 6 years ago, but when
she applied for Social Security disability benefits, she was denied.

“I
just started bawling. Because I felt like, if they looked at my records
or read these notes, surely they would understand my situation,” Hashmi
says.
Lisa Ekman, director of government affairs for the
National Organization of Social Security Claimants Representatives, says
Hashmi’s struggle with the application process is not unusual.
“It is not easy to get disability benefits. It’s a very complicated and difficult process,” Ekman says.
Right
now, just about 45 percent of people who apply for Social Security
disability benefits are accepted, and getting a hearing takes an average
of nearly 600 days.
The Kansas City office’s average hearing time is closer to 500 days, but its approval rate is slight lower at 40 percent.
The Backlog started snowballing about 10 years ago, around the time Jason
Fichtner became acting Deputy Commissioner of the Social Security
Administration (SSA).
He says that during the Great Recession, a lot of people who had disabilities applied but weren’t necessarily unable to work.
“But
they’re on the margin,” Fichtner says. “They can work, but when the
recession happens, those are the first people who tend to lose their
jobs, and then they apply for disability insurance.”
There are
now more than a million people across the country waiting for hearings.
Adding to the strain, the Social Security Administration’s core
operating budget has shrunk by 10 percent since 2010.
This
spring, the SSA introduced changes to fight fraud and streamline the
application process, including a new fraud-fighting measure that removes
the special consideration given to a person’s long-time doctor. (This is known as The Treating Physician's Rule)
Lisa
Ekman says this is a mistake.“Those changes would now put the
evidence from a treating physician on the same weight as evidence from a
medical consultant employed to do a one-time brief examination or a
medical consultant they had do a review of the paper file and may have
never examined the individual,” Ekman says.
She says this could
lead to more denials for disabled people with complex conditions like
lupus, multiple sclerosis or schizophrenia. These illnesses can affect
patients in very different ways and may be hard for an outside doctor or
nurse to assess.
She says more denials will lead to more appeals, which will only increase the backlog.She is correct. The Treating Physician's Opinion is controlling.https://judgelondonsteverson.me/2016/06/24/the-treating-physician-rule-is-controlling/
But
former administrator Fichtner, now a senior research fellow at George
Mason University’s Mercatus Center, says the SSA is obligated to weed
out any fraud it can, including the admittedly rare cases of treating
physicians tipping the scale in favor of their patients.
He says the SSA can still prioritize applicants.
“For
patients that are really in dire condition and really have major
disabilities, I don’t think they have to worry about this rule change,”
Fichtner says.
He acknowledges, however, that the backlog needs
attention and says the agency has safeguards to monitor whether the rule
is working.
Back in her kitchen in Lenexa, Stephenie Hashmi’s
husband Shawn prepares a family dinner she won’t be able to eat because
she’s having problems with her esophagus.
Stephenie puts on a
brave smile, but the progression of her illness and the ordeal with
Social Security have made her increasingly pessimistic.
After several rejections, she’s now on her final appeal. Her hearing is scheduled for November – of 2018.

(ByAlex Smith , Jun 7, 2017, Alex Smith is a health reporter, and she can reach him on Twitter @AlexSmithKCUR)

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